Vagal Nerve Stimulation in the Pediatric Population and Correlation Between Family and Treatment Team Perspectives: Single-center Experience.

BACKGROUND: Vagal nerve stimulation (VNS) is an adjunctive therapy to pharmacological treatment in patients with drug-resistant epilepsy. This study aimed to assess the efficacy of VNS therapy for seizure frequency reduction and improving quality of life (QOL) measures in children with refractory epilepsy and to evaluate the correlation between the perspectives of families and those of the treating team. METHODS: This was a prospective cohort study conducted at Abha Maternity and Children's Hospital, Saudi Arabia, from 2018 to 2022. A total of 21 pediatric patients who completed one year of follow-up after VNS implantation were included. Patients were aged between 2 and 14 years, with a mean age of 8.14 ± 3.92; 11 (52.4%) patients were female. Family and physician assessments were collected blinded to each other using Clinical Global Impression of Improvement (CGI-I) scores and QOL assessments to evaluate the correlation between the families' and treating team's perspectives on VNS outcomes. RESULTS: In this study involving 21 patients with intractable epilepsy, VNS showed significant efficacy in reducing the frequency of seizures. VNS significantly reduced the number of seizures per week from a baseline median of 35 to a median of 0.25 at the end of the follow-up period, representing a dramatic reduction of 99.3% (p < 0.001). The number of emergency department visits per year decreased from a baseline median of 12 to a median of 2, a reduction of 83.3% (p < 0.001), whereas the number of hospital admissions per year decreased from a baseline median of 3 to a median of 1, a 66.7% decrease (p < 0.001). The number of antiepileptic medications taken decreased from a median of 4 to 3 (p < 0.001). Notably, 28.57% of the patients achieved complete seizure freedom, and 38% exhibited significant improvement, with at least 50% reduction in seizure frequency. Importantly, none of the patients experienced an escalation in seizure frequency following VNS treatment. The family and physician assessments showed varying degrees of alignment in perceptions, with "concentration" exhibiting a significant positive correlation (r = 0.498, p = 0.022), indicating noteworthy agreement, whereas verbal communication did not show a substantial correlation (r = -0.062, p = 0.791), indicating a divergence of views. CONCLUSION: VNS is a promising and well-tolerated therapy for individuals with intractable seizures, offering clinical benefits and potential enhancements in various aspects of QOL. The varying perceptions between family and physician assessments highlight the importance of considering multiple perspectives when evaluating treatment outcomes.

Photoacoustic imaging in prostate cancer: A new paradigm for diagnosis and management.

The global health issue of prostate cancer (PCa) requires better diagnosis and treatment. Photoacoustic imaging (PAI) may change PCa management. This review examines PAI's principles, diagnostic role, and therapeutic guidance. PAI uses optical light excitation and ultrasonic detection for high-resolution functional and molecular imaging. PAI uses endogenous and exogenous contrast agents to distinguish cancerous and benign prostate tissues with greater sensitivity and specificity than PSA testing and TRUS-guided biopsy. In addition to diagnosing, PAI can guide and monitor PCa therapy. Its real-time imaging allows precise biopsies and brachytherapy seed placement. Photoacoustic temperature imaging allows non-invasive monitoring of thermal therapies like cryotherapy, improving treatment precision and success. Transurethral illumination probes, innovative contrast agents, integration with other imaging modalities, and machine learning analysis are being developed to overcome depth and data complexity restrictions. PAI could become an essential tool for PCa diagnosis and therapeutic guidance as the field advances.

Enhancing brain tumor diagnosis: an optimized CNN hyperparameter model for improved accuracy and reliability.

Hyperparameter tuning plays a pivotal role in the accuracy and reliability of convolutional neural network (CNN) models used in brain tumor diagnosis. These hyperparameters exert control over various aspects of the neural network, encompassing feature extraction, spatial resolution, non-linear mapping, convergence speed, and model complexity. We propose a meticulously refined CNN hyperparameter model designed to optimize critical parameters, including filter number and size, stride padding, pooling techniques, activation functions, learning rate, batch size, and the number of layers. Our approach leverages two publicly available brain tumor MRI datasets for research purposes. The first dataset comprises a total of 7,023 human brain images, categorized into four classes: glioma, meningioma, no tumor, and pituitary. The second dataset contains 253 images classified as "yes" and "no." Our approach delivers exceptional results, demonstrating an average 94.25% precision, recall, and F1-score with 96% accuracy for dataset 1, while an average 87.5% precision, recall, and F1-score, with accuracy of 88% for dataset 2. To affirm the robustness of our findings, we perform a comprehensive comparison with existing techniques, revealing that our method consistently outperforms these approaches. By systematically fine-tuning these critical hyperparameters, our model not only enhances its performance but also bolsters its generalization capabilities. This optimized CNN model provides medical experts with a more precise and efficient tool for supporting their decision-making processes in brain tumor diagnosis.

Advancing brain tumor detection: harnessing the Swin Transformer's power for accurate classification and performance analysis.

The accurate detection of brain tumors through medical imaging is paramount for precise diagnoses and effective treatment strategies. In this study, we introduce an innovative and robust methodology that capitalizes on the transformative potential of the Swin Transformer architecture for meticulous brain tumor image classification. Our approach handles the classification of brain tumors across four distinct categories: glioma, meningioma, non-tumor, and pituitary, leveraging a dataset comprising 2,870 images. Employing the Swin Transformer architecture, our method intricately integrates a multifaceted pipeline encompassing sophisticated preprocessing, intricate feature extraction mechanisms, and a highly nuanced classification framework. Utilizing 21 matrices for performance evaluation across all four classes, these matrices provide a detailed insight into the model's behavior throughout the learning process, furthermore showcasing a graphical representation of confusion matrix, training and validation loss and accuracy. The standout performance parameter, accuracy, stands at an impressive 97%. This achievement outperforms established models like CNN, DCNN, ViT, and their variants in brain tumor classification. Our methodology's robustness and exceptional accuracy showcase its potential as a pioneering model in this domain, promising substantial advancements in accurate tumor identification and classification, thereby contributing significantly to the landscape of medical image analysis.

Enhanced Regularized Ensemble Encoderdecoder Network for Accurate Brain Tumor Segmentation.

BACKGROUND: Segmenting tumors in MRI scans is a difficult and time-consuming task for radiologists. This is because tumors come in different shapes, sizes, and textures, making them hard to identify visually. OBJECTIVE: This study proposes a new method called the enhanced regularized ensemble encoder-decoder network (EREEDN) for more accurate brain tumor segmentation. METHODS: The EREEDN model first preprocesses the MRI data by normalizing the intensity levels. It then uses a series of autoencoder networks to segment the tumor. These autoencoder networks are trained using back-propagation and gradient descent. To prevent overfitting, the EREEDN model also uses L2 regularization and dropout mechanisms. RESULTS: The EREEDN model was evaluated on the BraTS 2020 dataset. It achieved high performance on various metrics, including accuracy, sensitivity, specificity, and dice coefficient score. The EREEDN model outperformed other methods on the BraTS 2020 dataset. CONCLUSION: The EREEDN model is a promising new method for brain tumor segmentation. It is more accurate and efficient than previous methods. Future studies will focus on improving the performance of the EREEDN model on complex tumors.

Cavernous Hemangioma in the Parotid Gland of an Adult: A Case Report and Review of Literature.

Hemangiomas are benign vascular tumors and are classified into cavernous, capillary, and mixed, with the head and neck area as the most common site. Hemangiomas are common in pediatrics and rare in adults. Diagnosing cavernous hemangioma is challenging and requires a complete history, proper physical examination, and several radiological modalities to improve diagnostic accuracy because it is uncommon in adults. Herein, we present a case of a 66-year-old female Saudi patient with cavernous hemangioma from the diagnosis until the surgical treatment. No previous studies are reported in Saudi Arabia and this is a rare presentation of cavernous hemangioma at this age. Cavernous hemangioma in the parotid gland in adults is uncommon and is difficult to diagnose. Therefore, a thorough physical examination and several radiological modalities are required to improve diagnostic accuracy. The most effective treatment of cavernous hemangioma in adults is surgical resection.

Real-Time Exposure to 3D-Printing Emissions Elicits Metabolic and Pro-Inflammatory Responses in Human Airway Epithelial Cells.

Three-dimensional (3D) printer usage in household and school settings has raised health concerns regarding chemical and particle emission exposures during operation. Although the composition of 3D printer emissions varies depending on printer settings and materials, little is known about the impact that emissions from different filament types may have on respiratory health and underlying cellular mechanisms. In this study, we used an in vitro exposure chamber system to deliver emissions from two popular 3D-printing filament types, acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA), directly to human small airway epithelial cells (SAEC) cultured in an air-liquid interface during 3D printer operation. Using a scanning mobility particle sizer (SMPS) and an optical particle sizer (OPS), we monitored 3D printer particulate matter (PM) emissions in terms of their particle size distribution, concentrations, and calculated deposited doses. Elemental composition of ABS and PLA emissions was assessed using scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM-EDX). Finally, we compared the effects of emission exposure on cell viability, inflammation, and metabolism in SAEC. Our results reveal that, although ABS filaments emitted a higher total concentration of particles and PLA filaments emitted a higher concentration of smaller particles, SAEC were exposed to similar deposited doses of particles for each filament type. Conversely, ABS and PLA emissions had distinct elemental compositions, which were likely responsible for differential effects on SAEC viability, oxidative stress, release of inflammatory mediators, and changes in cellular metabolism. Specifically, while ABS- and PLA-emitted particles both reduced cellular viability and total glutathione levels in SAEC, ABS emissions had a significantly greater effect on glutathione relative to PLA emissions. Additionally, pro-inflammatory cytokines including IL-1ß, MMP-9, and RANTES were significantly increased due to ABS emissions exposure. While IL-6 and IL-8 were stimulated in both exposure scenarios, VEGF was exclusively increased due to PLA emissions exposures. Notably, ABS emissions induced metabolic perturbation on amino acids and energy metabolism, as well as redox-regulated pathways including arginine, methionine, cysteine, and vitamin B3 metabolism, whereas PLA emissions exposures caused fatty acid and carnitine dysregulation. Taken together, these results advance our mechanistic understanding of 3D-printer-emissions-induced respiratory toxicity and highlight the role that filament emission properties may play in mediating different respiratory outcomes.

Colorectal cancer-related resource utilization and healthcare costs in Saudi Arabia.

Background: Recently, there has been an increase in the incidence of colorectal cancer in Saudi Arabia. Although numerous studies worldwide have investigated the economic burden of colorectal cancer the information specific to Saudi Arabia remains limited. While advanced cancer treatments offer substantial benefits, they they also come with substantial financial challenges. Objective: This study aimed to estimate the economic burden of colorectal cancer and identify the primary cost drivers. Method: This retrospective, single-center cost of illness study examined all patients with colorectal cancer from January 2017 to December 2020. This study used a micro-costing, bottom-up approach to estimate healthcare resource utilization and direct medical costs associated with colorectal cancer. Result: The study included 326 patients with colorectal cancer. The total direct medical cost for all patients were $19 million, with an annual cost per patient of $58,384. Medication costs were the primary driver of healthcare spending (45%) of the total cost, followed by surgical costs (27%). This study explained cost associated with colorectal cancer, which represents a significant cost to the Saudi healthcare budget. The expected growth and aging of the population and availability of costly treatments may lead to an increase in costs. These findings are valuable for healthcare policymakers seeking to comprehend the economic challenges posed by colorectal cancer.

Incidence and risk factors of contrast-induced nephropathy in acute stroke patients undergoing computed tomography angiography: A single-center study.

OBJECTIVES: To investigate the prevalence and risk factors linked to contrast-induced nephropathy in this specific patient population, aiming to ensure the highest quality of clinical care. METHODS: In a retrospective analysis, all patients who presented with an acute stroke to King Fahad Hospital, Jeddah, Emergency Department from March until November 2022 and underwent Computed Tomography Angiography (CTA) brain, Inclusion criteria were as follows: a baseline creatinine results and CTA examination performed within 24 hours of symptom onset and an available early (<5 days after CTA) follow-up creatinine result. RESULTS: Among 246 stroke patients in the emergency, 182 underwent brain CTA and 8.24% had Contrast-Induced Nephropathy (CIN). intracerebral hemorrhage (ICH) increased CIN risk 7-fold (OR=6.7; 95% CI: 1.23-33.3). Abnormal baseline raised CIN risk 8-fold (OR=7.8; 95% CI: 1.74-35.1). hypertension doubled the risk for CIN (OR=2.1; 95% CI: 1.26-6.98) CONCLUSION: The incidence of CIN was 8.2%, particularly elevated in patients with ICH, hypertension, tissue plasminogen administration, and abnormal baseline, necessitating vigilance in managing acute stroke cases.

Effect of smokeless tobacco on color stability and surface roughness of CAD/CAM milled, 3D printed, and conventional provisional crown and fixed dental prosthesis materials: An in vitro study.

BACKGROUND: Provisional fixed dental prosthesis (FDP) plays an important role during fixed prosthodontic therapy till the definitive. Discoloration of materials used for provisional FDPs can cause patient dissatisfaction and may create doubt about the color stability of the definitive FDP. Surface roughness is the other major property to be taken into consideration for provisional FDP materials. Smokeless tobacco is reported to affect the color stability and surface roughness of different prosthetic materials. OBJECTIVE: The aim of the current study was to evaluate the effect of two types of smokeless tobacco (black and white) on color stability and surface roughness of 3D printed, CAD/CAM milled, and conventional provisional FDP resin materials. METHODS: A total of 144 disc-shaped specimens were fabricated using four techniques CAD/CAM subtractive technique (milling), CAD/CAM additive technique (3D Printing), and conventional technique using autopolymerized PMMA, and autopolymerized Bis-acrylic resins. Each group was subdivided into three subgroups of twelve specimens each, and were submerged into three solutions (artificial salivary substitute, black smokeless tobacco, white smokeless tobacco). The change in color and surface roughness was evaluated and the data collected were statistically analyzed. RESULTS: It was observed that black smokeless tobacco caused the maximum color change and the effect was highest in autopolymerized PMMA resin specimens (ΔE = 9.343 ± 0.489), followed by 3D printed (ΔE = 7.187 ± 0.391), autopolymerized Bis-acryl (ΔE = 6.464 ± 0.453) and milled (ΔE = 4.978 ± 0.227). White smokeless tobacco was found to cause a maximum change in surface roughness and the effect was highest in autopolymerized Bis-acryl specimens (ΔRa = 0.321 ± 0.015 µm), followed by autopolymerized PMMA (ΔRa = 0.297± 0.015 µm), 3D printed (ΔRa = 0.191 ± 0.019 µm), and milled (ΔRa = 0.168 ± 0.014 µm). Statistically significant (p-value < 0.05) differences were observed among all techniques and solutions. CONCLUSIONS: The change in color and surface roughness were maximum in the case of FDPs prepared using autopolymerizing resins, followed by 3D printed, and CAD/CAM milled reins.

Exploring Gender Disparities in the Prevalence and Clinical Characteristics of Atherosclerotic Cranial Stenosis.

Background Atherosclerotic cranial stenosis (ACS) is a significant contributor to vascular events, including ischemic strokes. While early clinical studies suggested a divergence in the distribution of intracranial and extracranial stenosis between genders, recent evidence has highlighted the complexity of these disparities. Therefore, this study aims to investigate gender differences in the prevalence and clinical characteristics of atherosclerotic cranial stenosis in patients admitted with stroke. Methods This cross-sectional study was conducted at a tertiary care hospital located in the Southern Region of Saudi Arabia between June 2022 and December 2022. It included patients of all age groups who had been diagnosed with an ischemic stroke during the study period. Data were collected from electronic health records and medical archives, and data analysis was performed using Statistical Package for the Social Sciences (SPSS version 26, IBM Inc., Chicago, IL, USA). Results In our study, 201 stroke patients were analyzed, with 161 (80.09%) identified as having atherosclerotic stenosis. Of these, 57.8% were male, and 42.2% were female. Gender disparities were evident, with higher stenosis prevalence in males (46.27% vs. 33.83% in females). Significant gender differences were observed in dyslipidemia (p = 0.013), metabolic syndrome (p = 0.019), and smoking habits (p < 0.001). Males exhibited higher rates of extracranial stenosis (p = 0.012) and combined stenosis (p = 0.009) compared to females; however, females exhibited higher rates of intracranial stenosis (p = 0.013). Further analyses revealed significant associations in dyslipidemia (adjusted odd ratio (AOR): 0.245, p = 0.004), metabolic syndrome (AOR: 5.159, p = 0.006), obesity (AOR: 8.085, p = 0.016), smoking habits (AOR: 0.002, p < 0.001), and intracranial stenosis (AOR: 5.667, p = 0.005) within the female cohort. Conversely, age, hypertension, diabetes mellitus, ischemic heart disease, and extracranial stenosis did not show statistically significant associations in females (p > 0.05). Conclusion We observed a substantial presence of atherosclerotic cranial stenosis, with males showing higher rates, and identified significant gender-related variations in dyslipidemia, metabolic syndrome, and smoking habits as important factors. This highlights the necessity of tailoring ACS assessment and treatment by considering gender-specific risk factors and clinical characteristics for improved patient care and stroke management.

Frequency, Risk Factors, and Outcomes of Intracranial Atherosclerotic Stenosis in Stroke Patients From the Southern Region of Saudi Arabia.

Background Intracranial Atherosclerotic Stenosis (ICAS) represents a noteworthy cerebrovascular pathology linked to ischemic stroke, contributing to a considerable burden of morbidity and mortality on a global scale. The present study was undertaken with the primary objective of investigating the frequency, risk factors, and outcomes of ICAS in stroke patients within the Southern Region of Saudi Arabia. Methods This was a descriptive cross-sectional study conducted at a tertiary care hospital located in the southern region of Saudi Arabia, from June 2022 to December 2022. The study population consisted of patients aged 18 years and above who were diagnosed with acute ischemic stroke during the designated research period. Patients with hemorrhagic stroke, transient ischemic attack (TIA), or incomplete medical records were excluded from the analysis. Data pertaining to the patients were retrieved from their respective medical records. Results Out of 201 patients admitted with stroke, 92 (45.77%) were found to have intracranial stenosis. The majority of patients were female (52.2%) and aged over 55 years (60.9%). The presence of hypertension exhibited a statistically significant correlation with varying degrees of stenosis (p=0.02), as did ischemic heart disease and obesity (p=0.04) and active smoking (p=0.01). Hypertension displayed a marginal association with intracranial stenosis, with an odds ratio of 1.01 (95% CI: 0.25, 4.11) and a p-value of 0.02. Similarly, dyslipidemia showed a potential correlation, with an odds ratio of 1.16 (95% CI: 0.44, 3.03) and a p-value of 0.014. On the other hand, obesity showed a stronger association, with an odds ratio of 4.53 (95% CI: 1.05, 19.51) and a p-value of 0.04. Among the patients, 25 (27.17%) underwent revascularization procedures, while 44 (47.83%) were not eligible for such intervention. During the three-month follow-up, 4 (16%) experienced an ipsilateral stroke, and 3 (12%) suffered from a contralateral transient ischemic attack (TIA). Encouragingly, 18 (72%) of the treated patients showed no recurrence during the follow-up period. Conclusion This study concludes that approximately half (45.77%) of stroke patients had intracranial stenosis, and significant associations were found between varying degrees of stenosis and hypertension, ischemic heart disease, obesity, and active smoking. Hypertension demonstrated a marginal correlation, while obesity exhibited a stronger association with intracranial stenosis.

Advancing Brain Tumor Classification through Fine-Tuned Vision Transformers: A Comparative Study of Pre-Trained Models.

This paper presents a comprehensive study on the classification of brain tumor images using five pre-trained vision transformer (ViT) models, namely R50-ViT-l16, ViT-l16, ViT-l32, ViT-b16, and ViT-b32, employing a fine-tuning approach. The objective of this study is to advance the state-of-the-art in brain tumor classification by harnessing the power of these advanced models. The dataset utilized for experimentation consists of a total of 4855 images in the training set and 857 images in the testing set, encompassing four distinct tumor classes. The performance evaluation of each model is conducted through an extensive analysis encompassing precision, recall, F1-score, accuracy, and confusion matrix metrics. Among the models assessed, ViT-b32 demonstrates exceptional performance, achieving a high accuracy of 98.24% in accurately classifying brain tumor images. Notably, the obtained results outperform existing methodologies, showcasing the efficacy of the proposed approach. The contributions of this research extend beyond conventional methods, as it not only employs cutting-edge ViT models but also surpasses the performance of existing approaches for brain tumor image classification. This study not only demonstrates the potential of ViT models in medical image analysis but also provides a benchmark for future research in the field of brain tumor classification.

Brain Tumor Detection and Classification Using Fine-Tuned CNN with ResNet50 and U-Net Model: A Study on TCGA-LGG and TCIA Dataset for MRI Applications.

Nowadays, brain tumors have become a leading cause of mortality worldwide. The brain cells in the tumor grow abnormally and badly affect the surrounding brain cells. These cells could be either cancerous or non-cancerous types, and their symptoms can vary depending on their location, size, and type. Due to its complex and varying structure, detecting and classifying the brain tumor accurately at the initial stages to avoid maximum death loss is challenging. This research proposes an improved fine-tuned model based on CNN with ResNet50 and U-Net to solve this problem. This model works on the publicly available dataset known as TCGA-LGG and TCIA. The dataset consists of 120 patients. The proposed CNN and fine-tuned ResNet50 model are used to detect and classify the tumor or no-tumor images. Furthermore, the U-Net model is integrated for the segmentation of the tumor regions correctly. The model performance evaluation metrics are accuracy, intersection over union, dice similarity coefficient, and similarity index. The results from fine-tuned ResNet50 model are IoU: 0.91, DSC: 0.95, SI: 0.95. In contrast, U-Net with ResNet50 outperforms all other models and correctly classified and segmented the tumor region.

A nationwide survey of public COPD knowledge and awareness in Saudi Arabia: A population-based survey of 15,000 adults.

BACKGROUND: There is a concerning lack of representative data on chronic obstructive pulmonary disease (COPD) awareness in Saudi Arabia, and a significant proportion of the population is vulnerable to developing a smoking habit, which is a major risk factor for the disease. METHODS: Population-Based Survey of 15,000 people was conducted to assess the public knowledge and awareness of COPD across Saudi Arabia from October 2022 to March 2023. RESULTS: A total of 15002 responders completed the survey, with a completion rate of 82%. The majority 10314 (69%) were 18-30 year and 6112 (41%) had high school education. The most common comorbidities among the responders were depression (7.67%); hypertension (6%); diabetes (5.77%) and Chronic Lung Disease (4.12%). The most common symptoms were dyspnea (17.80%); chest tightness (14.09%) and sputum (11.19%). Among those who complains of any symptoms, only 16.44% had consulted their doctor. Around 14.16% were diagnosed with a respiratory disease and only 15.56% had performed pulmonary function test (PFT). The prevalence of smoking history was 15.16%, in which current smokers were 9.09%. About 48% of smokers used cigarette, 25% used waterpipe and around 27% were E-cigarette users. About 77% of the total sample have never heard about COPD. Majority of current smokers (73.5%; 1002), ex-smokers (68%; 619), and non-smokers (77.9%; 9911) are unaware of COPD, p value <0.001. Seventy five percent (1028) of the current smokers and 70% (633) of the ex-smokers have never performed PFT, p value <0.001. Male, younger age (18-30 years), higher education, family history of respiratory diseases, previous diagnosis of respiratory disease, previous PFT, and being an ex-smokers increases the odds of COPD awareness, p-value <0.05. CONCLUSION: There is a significantly low awareness about COPD in Saudi Arabia, especially among smokers. A nationwide approach must include targeted public awareness campaigns, continued healthcare professional education, community-based activities encouraging diagnosis and early detection, advice on smoking cessation and lifestyle changes, as well as coordinated national COPD screening programs.

Magnetic Resonance Imaging Features of Rhino-Orbito-Cerebral Mucormycosis in Post-COVID-19 Patients: Radio-Pathological Correlation.

There has been a notable increase in rhino-orbito-cerebral mucormycosis (ROCM) post-coronavirus disease 2019 (COVID-19), which is an invasive fungal infection with a fatal outcome. Magnetic resonance imaging (MRI) is a valuable tool for early diagnosis of ROCM and assists in the proper management of these cases. This study aimed to describe the characteristic MRI findings of ROCM in post-COVID-19 patients to help in the early diagnosis and management of these patients. This retrospective descriptive study was conducted at a single hospital and included 52 patients with COVID-19 and a histopathologically proven ROCM infection who were referred for an MRI of the paranasal sinuses (PNS) due to sino-orbital manifestations. Two radiologists reviewed all the MR images in consensus. The diagnosis was confirmed by histopathological examination. The maxillary sinus was the most commonly affected PNS (96.2%). In most patients (57.7%), multiple sinuses were involved with the black turbinate sign on postcontrast images. Extrasinus was evident in 43 patients with orbital involvement. The pterygopalatine fossa was involved in four patients. Three patients had cavernous sinus extension, two had pachymeningeal enhancement, and one had epidural collection. The alveolar margin was affected in two patients, and five patients had an extension to the cheek. The awareness of radiologists by the characteristic MRI features of ROCM in post-COVID-19 patients helps in early detection, early proper management, and prevention of morbid complications.

A rat model of rheumatoid arthritis: TDZD-8 is associated with the protection against the induction of the synovium knee joint IL-17A/GSK3beta/ROS/alpha-SMA axis of fibrosis / Un modelo de rata de artritis reumatoide: TDZD-8 está asociado con la protección contra la inducción del eje de fibrosis de la articulación sinovial de la rodilla IL-17A/GSK3ß/ROS/α-SMA

SUMMARY: Rheumatoid arthritis (RA) that affects the synovial knee joint causes swelling of the synovial membrane and tissue damage. Interleukin-17A (IL-17A) and the enzyme glycogen synthase kinase-3β (GSK3β) are involved in the pathogenesis of RA. The link between IL-17A, GSK3β, the oxidative stress, and the profibrogenic marker alpha-smooth muscle actin (α-SMA) with and without TDZD-8, GSK3β inhibitor has not been studied before. Consequently, active immunization of rats was performed to induce RA after three weeks using collagen type II (COII) injections. The treated group received daily injection of 1 mg/kg TDZD-8 for 21 days following the immunization protocol (COII+TDZD-8). Blood and synovium tissue samples were harvested at the end of the experiment. RA development was confirmed as corroborated by a substantial increase in blood levels of the highly specific autoantibody for RA, anti-citrullinated protein antibody as well as augmentation of reactive oxidative species (ROS) levels measured as lipid peroxidation. RA induction also increased synovium tissue levels of IL-17A and the profibrogenic marker, α-SMA. All these parameters seemed to be significantly (p<0.0001) ameliorated by TDZD-8. Additionally, a significant correlation between IL-17A, ROS, and α-SMA and biomarkers of RA was observed. Thus, knee joint synovium RA induction augmented IL-17A/GSK3β/ROS/α-SMA axis mediated arthritis in a rat model of RA, which was inhibited by TDZD-8.

La artritis reumatoide (AR) que afecta la articulación sinovial de la rodilla provoca inflamación de la membrana sinovial y daño tisular. La interleucina-17A (IL-17A) y la enzima glucógeno sintasa quinasa-3β (GSK3β) están involucradas en la patogenia de la AR. No se ha estudiadol vínculo entre IL-17A, GSK3β, el estrés oxidativo y el marcador profibrogénico actina de músculo liso alfa (α-SMA) con y sin inhibidor de TDZD-8, GSK3β. En consecuencia, se realizó una inmunización activa de ratas para inducir la AR después de tres semanas usando inyecciones de colágeno tipo II (COII). El grupo tratado recibió una inyección diaria de 1 µg/ kg de TDZD-8 durante 21 días siguiendo el protocolo de inmunización (COII+TDZD-8). Se recogieron muestras de sangre y tejido sinovial al final del experimento. El desarrollo de AR se confirmó como lo corroboró el aumento sustancial en los niveles sanguíneos del autoanticuerpo altamente específico para AR, el anticuerpo antiproteína citrulinada, así como el aumento de los niveles de especies oxidativas reactivas (ROS) medidos como peroxidación lipídica. La inducción de AR también aumentó los niveles de tejido sinovial de IL-17A y el marcador profibrogénico, α-SMA. Todos estos parámetros parecían mejorar significativamente (p<0,0001) con TDZD-8. Además, se observó una correlación significativa entre IL- 17A, ROS y α-SMA y biomarcadores de AR. Por lo tanto, la inducción de AR en la sinovial de la articulación de la rodilla aumentó la artritis mediada por el eje IL-17A/GSK3β/ROS/α-SMA en un modelo de rata de AR, que fue inhibida por TDZD-8.

A Rat Model of Rheumatoid Arthritis: TDZD-8 is Associated with the Protection Against the Induction of the Synovium Knee Joint IL-17A/GSK3β/ROS/α-SMA Axis of Fibrosis

SUMMARY: Rheumatoid arthritis (RA) that affects the synovial knee joint causes swelling of the synovial membrane and tissue damage. Interleukin-17A (IL-17A) and the enzyme glycogen synthase kinase-3β (GSK3β) are involved in the pathogenesis of RA. The link between IL-17A, GSK3β, the oxidative stress, and the profibrogenic marker alpha-smooth muscle actin (α-SMA) with and without TDZD-8, GSK3β inhibitor has not been studied before. Consequently, active immunization of rats was performed to induce RA after three weeks using collagen type II (COII) injections. The treated group received daily injection of 1 mg/kg TDZD-8 for 21 days following the immunization protocol (COII+TDZD-8). Blood and synovium tissue samples were harvested at the end of the experiment. RA development was confirmed as corroborated by a substantial increase in blood levels of the highly specific autoantibody for RA, anti-citrullinated protein antibody as well as augmentation of reactive oxidative species (ROS) levels measured as lipid peroxidation. RA induction also increased synovium tissue levels of IL-17A and the profibrogenic marker, α-SMA. All these parameters seemed to be significantly (p<0.0001) ameliorated by TDZD-8. Additionally, a significant correlation between IL-17A, ROS, and α-SMA and biomarkers of RA was observed. Thus, knee joint synovium RA induction augmented IL-17A/GSK3β/ROS/α-SMA axis mediated arthritis in a rat model of RA, which was inhibited by TDZD-8.

La artritis reumatoide (AR) que afecta la articulación sinovial de la rodilla provoca inflamación de la membrana sinovial y daño tisular. La interleucina-17A (IL-17A) y la enzima glucógeno sintasa quinasa-3β (GSK3β) están involucradas en la patogenia de la AR. No se ha estudiadol vínculo entre IL-17A, GSK3β, el estrés oxidativo y el marcador profibrogénico actina de músculo liso alfa (α-SMA) con y sin inhibidor de TDZD-8, GSK3β. En consecuencia, se realizó una inmunización activa de ratas para inducir la AR después de tres semanas usando inyecciones de colágeno tipo II (COII). El grupo tratado recibió una inyección diaria de 1 µg/ kg de TDZD-8 durante 21 días siguiendo el protocolo de inmunización (COII+TDZD-8). Se recogieron muestras de sangre y tejido sinovial al final del experimento. El desarrollo de AR se confirmó como lo corroboró el aumento sustancial en los niveles sanguíneos del autoanticuerpo altamente específico para AR, el anticuerpo antiproteína citrulinada, así como el aumento de los niveles de especies oxidativas reactivas (ROS) medidos como peroxidación lipídica. La inducción de AR también aumentó los niveles de tejido sinovial de IL-17A y el marcador profibrogénico, α-SMA. Todos estos parámetros parecían mejorar significativamente (p<0,0001) con TDZD-8. Además, se observó una correlación significativa entre IL- 17A, ROS y α-SMA y biomarcadores de AR. Por lo tanto, la inducción de AR en la sinovial de la articulación de la rodilla aumentó la artritis mediada por el eje IL-17A/GSK3β/ROS/α-SMA en un modelo de rata de AR, que fue inhibida por TDZD-8.

Effects of Smokeless Tobacco on Color Stability and Surface Roughness of 3D-Printed, CAD/CAM-Milled, and Conventional Denture Base Materials: An In Vitro Study.

Tobacco consumption in its different forms can affect the optical and surface properties of dental materials that are used in the oral cavity. Thus, the present study was conducted to evaluate the effects of two commercially available smokeless tobacco products on the color stability and surface roughness of denture base resins that were fabricated using three different techniques (CAD/CAM milling, 3D printing, and conventional heat polymerization). A total of 126 denture base resin specimens were fabricated using the three different manufacturing techniques (n = 42 each). Specimens from each group were further subdivided into three subgroups (n = 14 each) and immersed in three different immersion media (a khaini suspension, a tabbaq suspension, and artificial saliva). The differences in color and surface roughness were assessed according to data that were collected and statistically analyzed using SPSS version 24.0. The tabbaq smokeless tobacco was found to cause greatest changes in color and surface roughness; the effect was observed to be highest in the 3D-printed specimens followed by the conventional heat-polymerized and CAD/CAM milled specimens. The mean changes in color and surface roughness were the highest for the tabbaq smokeless tobacco followed by the khaini smokeless tobacco and the artificial saliva. Statistically significant (p-value < 0.05) differences were observed among all techniques and suspensions. We concluded that the mean changes in color and surface roughness were significantly higher for the 3D-printed dentures compared to the conventional heat-polymerized and CAD/CAM-milled dentures. Thus, the results of the present study strengthened the concept that tobacco in any form can lead to changes in the color and surface roughness of denture base materials.

Retentive Forces and Deformation of Fitting Surface in RPD Clasp Made of Polyether-Ether-Ketone (PEEK).

BACKGROUND: Polyetheretherketone (PEEK) has provided the option to fabricate RPDs with aesthetics unlike metal RPDs, but little attention has been paid to its suitability, especially towards the retentive forces and deformation of the clasp. This study aimed to examine the retentive forces and the fitting surface (inner surface) deformation of clasps made from PEEK and compare it with cobalt-chromium (Co-Cr) clasp. METHODS: Forty-two circumferential clasps (14 Co-Cr and 28 PEEK) were fabricated and divided into two groups with clasp undercuts (0.25 mm and 0.5 mm) with thicknesses of 1 mm and 1.5 mm. Each was examined for retentive forces after cycle test on its abutment for 360 cycles. Initial and final retentive forces were recorded. The fitting surface deformation was determined using 3-Matic research analysis software. RESULTS: The results revealed that highest mean initial retentive force was of Co-Cr clasps with 0.50 mm undercut 22.26 N (±10.15 N), and the lowest was the 1 mm PEEK clasps with 0.25 mm undercut 3.35 N (±0.72 N) and highest mean final retentive force was the Co-Cr clasps with 0.50 mm undercut 21.40 N (±9.66 N), and the lowest was the 1 mm PEEK clasps with 0.25 mm undercut 2.71 N (±0.47 N). PEEK clasps had a lower retentive force than Co-Cr clasps with 0.50 undercut. PEEK clasps (1.5 mm) at 0.25 mm undercut had the least deformation (35.3 µm). PEEK showed significantly less deformation (p ≤ 0.014) than Co-Cr. CONCLUSION: The deformation of PEEK clasps fitting surface was lower than Co-Cr clasps and retentive forces were close to the Co-Cr clasps, suggesting the use of PEEK as an aesthetic clasp option for RPD framework.